Dental MythBuster #15: I Don’t Have to be Numb to Have an Extraction of a Tooth That’s Had a Root Canal

This is one dental myth that I personally don’t see too often. On average, I see it approximately once a month. This myth is based on this perception: because a root canal treated tooth has no nerve, if it needs to be extracted, then you don’t have to be numb (since the nerve is gone).

On the surface, this might make sense. After all, if there is no nerve, you won’t feel anything, right? Well, it turns out that is not the case. Let’s see why:

What Root Canal Treatment Does

When a root canal is performed, the nerve tissue that lies deep inside the tooth is removed, and then that space is filled with a special filling material. The two x-rays on the left illustrate this. The top one shows the pre-operative condition of the tooth and the bottom x-ray shows the completion of the procedure with a filling material in the root canal space.

Once complete, because the nerve is now gone, the tooth will no longer be able to feel hot or cold. So if you try to swish really cold water around a tooth that’s had a root canal, you won’t feel it.

However, there are still plenty of things around the tooth that are still “alive.” The gum tissue around the tooth is alive. The ligament that holds the tooth in the socket is still alive. If you bite down hard on the tooth – you’ll feel it. All of these things…

Why You Have to be Numb for Tooth Extractions

Elevator used for extractions.

This may sound slightly obvious. But, to bust this myth, we need to understand why.

When a tooth is extracted, local anesthesia is given to numb the nerves associated with the tooth. What nerves would those be? They include:

The nerves of the tooth itself.

The nerves going to the ligaments holding the tooth in the socket.

The nerves going to the bone immediately surrounding the ligaments and tooth.

The nerves going to the adjacent teeth.

The gum tissue around the tooth.

When that tooth is extracted, great forces are exerted on not just the tooth, but the surrounding tissue. One of the instruments used is a dental elevator, which is pictured to the right. This instrument pushes the tooth out but does so by placing reciprocal forces on the structures next to the teeth.

No Local Anesthesia = Pain

Even though the tip of your fingernail can’t feel much, try pulling out the nail itself!

So what would happen if an extraction was attempted on a tooth that’s had a root canal but without local anesthesia (a.k.a no “novocaine“)?

OUCH!

When the elevator is inserted (or other instrument for that matter) – the tooth itself might not “feel” anything, but the surrounding tissue will.

An analogy to how it would feel might be like having a fingernail pulled off. Sure, you can cut the tip of your fingernail and not feel anything – but try to pull it off – and you’ll be in a lot of pain!

So, if you need to have a tooth extracted, and that tooth has had a root canal – you’ll need to very numb.

Tom,
You must be very tough and the tooth must have been very loose! Occasionally, an extraction of a broken tooth that has had a root canal can take over 10 minutes and require cutting of gums and bone. That would not be pleasant if you were not numb.

I’d never heard that myth. I’ve had two upper premolars and one lower molar pulled with no local. Fortunately, they were uncomplicated, out quickly, and not excruciatingly painful. (2 had root canals, one nerve was dead, none was loose) I took Tylenol for the premolars. I have been forced to do most of my recent dental work without local, because they don’t use the kind I can use in the country I live in. Barring emergencies, from now on I will get dental care in Thailand or the U.S. where I can get proper pain control.

I’ve also had numerous deep fillings done with no anesthetic. I do have very high pain tolerance, apparently, but by far the worst was a root canal I had done today with three live nerves.That was my worst nightmare, but I toughed it out. I found this site when I was looking up how much stuff is supposed to hurt. Scraping out live nerve tissue hurts like hell, but it can be done. I definitely recommend oral painkiller first. My dentist and I thought the nerve was dead so I didn’t take any. The good thing about dental pain is that the really bad stuff is over quickly. Painwise, I’d get a tooth pulled any day over that root canal.

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